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The 'Un'-Affordable Care Act is a weak start

By David E. Drake, D.O.
The Des Moines Register, March 10, 2015

Potential 2016 presidential candidate Sen. Bernie Sanders has stated: "There is one major country on Earth that does not guarantee health care as a right for all. There is one major country on Earth that spends twice as much per capita on health care as almost any other. There is one major country on Earth where private insurance companies and drug companies earn huge profits. Guess which country."

As a physician in private practice I abhor each coming new year. This is the time when health care practices have to deal with patients with new insurance policies and former policies with stringent regulations. This year, more than any previous time, I'm noticing more and more folks who have high deductibles — allowed up to $6,600 with the Affordable Care Act (Obamacare). And for some folks that means they can't see me or they have to greatly limit the number of times they can receive services from me.

In some cases I have to refer middle-class folks with these high deductibles to places with sliding scales, places I used to refer indigent folks with no insurance. Not seeking or delaying care can lead to delayed diagnoses and possible tragic consequences. And as Michael Moore has pointed out, now it's the middle class who are hit with being under- or poorly-insured while more indigent folks now have an expansion of Medicaid. The confusing mix of deductibles, co-pays, co-insurance and limitations on what services can be provided are now daily frustrations with our lack of guaranteed health care for all.

A single-payer system of reimbursement for health care services has never seemed more in need, with 38 percent of Americans citing health care costs they pay out of pocket as a somewhat or significant level of stress, according to the physician website Doximity. 

Health care bills could go to one payer — an expansion and enhancement of Medicare — with a great reduction in administrative costs for paying the bills and for providers of health care and their offices. Single payer does not imply a system like the Veterans Administration, where all the providers are employees, but one that allows for private as well as employed practices.

Other Iowans join me in their support for moving the ACA past the private insurance companies as the regulating and paying source.

Maureen McCue, adjunct clinical professor at the University of Iowa, medical director of the Women's Clinic, and Coordinator of the Iowa Chapter of Physicians for Social Responsibility, wrote me:

"Tinkering at the edges doing little to rein in the excesses of the profit-driven insurance system, pharmaceutical and biotech industries, and others. While allowing more citizens access to health insurance, the complexity of the new insurance mechanisms means accessing the health system itself has become ever more confusing and obtuse."

Dr. McCue offers hope for a change. "It doesn't have to be this way. There are tried and true solutions. The world's healthiest populations pay far less for medical services."

Douglas Steenblock is a physician from Marshalltown with extensive experience working in both the private and public sectors in his field of psychiatry. "It is unfortunate that Americans are so polarized when it comes to our medical system. Many people seem to think that any departure from our current profit-driven system represents 'socialized medicine' and that there is nothing in between the two extremes. I find it interesting that the ACA has been described as 'government-run healthcare,' when it is actually appears to be private healthcare run amok. The healthcare industry stands to profit handsomely from Obamacare, which explains why it was allowed to pass in the first place."

Former state Rep. Ed Fallon wrote me: "While some aspects of the ACA move us forward toward a more fair and just health care system, the insurance industry remains the entrenched powerhouse that pulls the purse strings and calls the shots."

Middle-class Iowans and Americans in general have much to gain from moving beyond the ACA. We will get to equitable health care for all in the U.S. It is simply the right thing to do.

Dr. David E. Drake is an adjunct clinical professor at Des Moines University and a relationship psychiatrist in private practice. Contact: drakeoffice@gmail.com

http://www.desmoinesregister.com/story/opinion/columnists/iowa-view/2015...